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Disculpen la dispersión de bulos, vi el vídeo en dos canales distintos que considero de fiar, y aunque daba sentado que el tal doctor sería amigo de medicinas alternativas y diversas historias di por hecho que la detención se debía a motivos covidianos. Checkeare bien las
983472 5 hours ago [–]> That guy is not even a medical doctorWhat is he a doctor in? warpspin 3 hours ago [–]Apparently chemistry. He's practicing as a kind of nutritionist with some strange esoteric views.It seems the police stormed multiple apartments in that house after being tipped off about illegal drug dealing. This is totally not related at all to COVID or the lockdown and it seems not even specifically targetted at him.
La jefatura de policía de Franconia Media confirmó el viernes que se trataba de una operación real. Pero esto no fue dirigido contra el operador de la transmisión en vivo, enfatizó una portavoz de la policía.Debido a que el hombre había criticado repetidamente las medidas de Corona aplicables en sus videos, los usuarios de Internet habían especulado sobre una conexión con el uso. La portavoz enfatizó que esto no tenía referencia de corona. Para obtener más información, se refirió a la Fiscalía de Berlín.Allí, un portavoz solo dijo que "probablemente" se trataba de un uso en conexión con narcóticos. Posiblemente podría dar más información el viernes.
Nassim Nicholas Taleb @nntalebThis is the study used by the "anti-mask" crowd.It says:"We are not sure whether wearing a mask OUTSIDE YOUR HOUSE (but not at home) will give you more protection than distancing from catching Covid INSIDE YOUR HOUSE."Statistically, junk!Wear a Mask!https://acpjournals.org/doi/10.7326/M20-6817
Nassim Nicholas Taleb @nntaleb · 3hTHE DANISH STUDY, 2I cannot believe this was published in a real medical journal (although after numerous rejections).
Nassim Nicholas Taleb @nntaleb · 3hMy take 5 months ago https://medium.com/incerto/the-masks-masquerade-7de897b517b7
Nassim Nicholas Taleb @nntaleb · 21hDISCUSSION:I am in favor of masks & intransigent w/Twitter unrigorous babble; but one must ethically try to have a fresh look when facing a new study. Let's do an objective analysis of this study to see if has any merit, if it can change one's mind, etc.CitarJames Todaro, MD @JamesTodaroMD · 18 NovBREAKING: Danish mask study that JAMA, NEJM & Lancet REFUSED to publish was just published in Annals of Internal Medicine.In the largest randomized controlled trial to date w/ 6,024 subjects, medical masks were NOT effective protection against infection.https://acpjournals.org/doi/10.7326/M20-6817…
James Todaro, MD @JamesTodaroMD · 18 NovBREAKING: Danish mask study that JAMA, NEJM & Lancet REFUSED to publish was just published in Annals of Internal Medicine.In the largest randomized controlled trial to date w/ 6,024 subjects, medical masks were NOT effective protection against infection.https://acpjournals.org/doi/10.7326/M20-6817…
Nassim Nicholas Taleb @nntaleb2) For starters the paper does'nt make the claim by "James Todaro, MD", that masks were NOT effective.Worse, there is in fact a big problem w/the study: it is ONLY saying:"If you have exposure to COVID inside your house, wearing a mask in the garden won't protect you".
Nassim Nicholas Taleb @nntaleb · 21h3) Aside from some statistical problems, this is junk. A proper study should be:"What is the risk reduction for those catching COVID OUTSIDE their house" by eliminating at home infections, which is the BULK of the spreading.
Nassim Nicholas Taleb @nntaleb · 20h4) Simply, it turns out that the "James Todaro, MD" in question either has not practiced medicine or dropped out early, & is a bitcoin operator, part of the cluster bitcoin=no masks =... .
Here's what happened when I posted our latest @spectator article to Facebook - I'm aware this is happening to others - what has happened to academic freedom and freedom of speech? There is nothing in this article that is 'false'
Noah Haber - @NoahHaber: Results-driven critique is a problem, as others have noted recently (most prominently @VPrasadMDMPH)However, that does not invalidate the critique, is not universally true for all those leveraging critique, and it is also not necessarily driven by "bias."Brief thread.CitarBishal Gyawali - @oncology_bg: A question I’ve been thinking about the Danish mask study. Yes, the study has several limitations. But if the study had shown opposite results, would the #medtwitter community have criticized the study equally for these limitations?
Bishal Gyawali - @oncology_bg: A question I’ve been thinking about the Danish mask study. Yes, the study has several limitations. But if the study had shown opposite results, would the #medtwitter community have criticized the study equally for these limitations?
Noah Haber - @NoahHaber: First, to acknowledge that this is a real problem, and should not be dismissed. Credibly study critique needs to be based in the methods regardless of results, and there are many clearly willing to give poor methods a pass when the results fit their priors.It's real.
Noah Haber - @NoahHaber: However, when good, well thought out critique, it's still good critique, and should be heeded regardless of its provenance.It's not always good (you can certainly find PLENTY of misguided critique of the DANMASK trial out there), and it takes effort to sort which is which.
Noah Haber - @NoahHaber: It's also often far murkier than many would like. Errors are errors, but there is always a degree of subjectivity in methods critique.But again, if it's valid, well thought out critique done in good faith, it applies. Period.
Noah Haber - @NoahHaber: Just as we shouldn't condition our critique on the results, we shouldn't condition whether we accept critique on where it comes from (except perhaps in cases where we are actively trying to assess an entire literature, not one study).
Noah Haber - @NoahHaber: We should accept critique based on the quality of the method of critique, just as we should accept studies based on the quality of the method of the studies.Secondly, there are MANY folks who make it their lives to critique methods, regardless of the results. Find them.
Noah Haber - @NoahHaber: Many of my colleagues and I (I am going to speak my own experience, have a grain of salt handy) have spent our lives getting good at identifying methodological flaws and understanding the broader research meta, and figuring out how to do the best critique possible.
Noah Haber - @NoahHaber: When my colleagues and I critiqued the methods behind the DANMASK study, this wasn't even REMOTELY the first mask study critiquedThe one we lost the most sleep over by a long shot was this one, which concluded that masks were extremely effective.https://www.nytimes.com/2020/06/18/health/coronavirus-retractions-studies.html
Noah Haber - @NoahHaber: I've stated this before, but if I have a results-driven bias, it's more likely that I err on the side of overcompensation critiquing studies whose conclusions I agree with.But again, have a grain of salt, we are rarely the best judges of ourselves.
Noah Haber - @NoahHaber: I'll compile a list of some folks who I've learned to trust with regard to fair and well-thought out critique done in good faith regardless of the results in the near future, so that others can seek them out.If you know who to look for, you can ignore the noise.
Noah Haber - @NoahHaber: In the case of the DANMASK-19 trial, we made our critique on the methods and predictions, BEFORE the results came out (credit to the DANMASK trial authors for making their design available before results publication).I wish this was how it could always be done.
Noah Haber - @NoahHaber: The DANMASK trial is a slightly unusual case, because the design of the trial completely determined the results. There is never a strict separation between methods and results, but for the DANMASK trial they were effectively one and the same. So, grain of salt again.
Noah Haber - @NoahHaber: Now, as for why this isn't as big a problem as some might assume, we have to get a little causal inference-y (draw a DAG if ya like), and think about WHY results-driven critique happens.There are a few steps here, so bear with me.
Noah Haber - @NoahHaber: More critique happens for higher profile studies.Weaker methods tend to produce more extreme resultsWeak methods -> extreme results -> out of line with expectations -> high profileWe tend to (BUT NOT ALWAYS) get more critique when methods are worse, even when results-driven
Noah Haber - @NoahHaber: Should we rest satisfied by that? ABSOLUTELY NOT.But it does mean that we should not be dismissing valid critique just because it's high profile or (partially) driven by the results.We should avoid spending more time casting doubt on the robust critique than the weak study.
Noah Haber - @NoahHaber: Yes, I do understand the meta-irony here.But then again, you probably shouldn't trust me, because I said this would be a brief thread.Honestly, you're probably out of salt by now.
Noah Haber - @NoahHaber: This was a clear case where that is not true. We had the trial design months before we had the results
Noah Haber - @NoahHaber: Pre-registering my predictions on this trial: https://clinicaltrials.gov/ct2/show/NCT04337541Unending recruitment/consent issues, extremely low compliance, spillovers, and poor power.Results will be null, but having nothing to do with whether masks are effective (they almost certainly are).
Noah Haber - @NoahHaber: I would LOVE to be wrong, but the structural issues in the design and reality of attempting to do such a trial all point toward severe bias toward the null and low power.In my opinion, these problems are virtually insurmountable.
Noah Haber - @NoahHaber: This comes with an extreme danger, and my second pre-registered prediction: if/when this trial comes back with null results, it will be incorrectly translated across nearly everything (social media, traditional media, and, yes, academic research) as showing masks are ineffective.
Noah Haber - @NoahHaber: Assuming I am right (and again, I sincerely and truly hope my predictions are wrong), should we have done this trial in the first place?Will we learn anything useful?Will the problems result in better or worse decision making?Is it even ethical to have tried?
Noah Haber - @NoahHaber: To be more precise: when I say severe bias toward the null, I am referring specifically relative to the effect that the trialists intend to measure (whether/how much mask use reduces COVID-19 infection, though I think they meant SARS-CoV-2 here).
Noah Haber - @NoahHaber: Aug 28 retroactive clarity (still no results, so I don't feel that I am violating my pre-registration, but worth noting): The written intent is the impact of INDIVIDUAL assignment.They are not (nor did they claim) to be testing mask POLICY, which is a whole other thing.
Noah Haber - @NoahHaber: Just had a quick look at Denmark's case load out of curiosity. Recruitment started April 2, ended June 2 (according to the registration).During that time, there were 8,644 detected cases (488 deaths) in ALL OF DENMARK.Let's do some math here.
Noah Haber - @NoahHaber: Adult population of Denmark is 4,624,643. So we would expect to see about 11 TOTAL cases (6000*8644/4,624,643) to be within the population cohort.(btw, I am doing this live, I honestly don't know what I'm about to come up with, will compile sources at the end).
Noah Haber - @NoahHaber: Let's call it 30 cases, since cases are far more likely to be detected in an RCT than in the population.How big of an effect must there be to detect an effect, assuming perfect compliance, alpha=.05, no spillovers, frictionless plane in a vacuum, etc.?
Noah Haber - @NoahHaber: Let's use our good friend simulation to help us hereWe'll assume that the p of being a case in the control arm is 3x the population prob (3*8644/4624643), and see how big an effect we must have (i.e. relative protective effect) in order to detect it.https://twitter.com/noahhaber/status/1095740484302110720
Noah Haber - @NoahHaber: Just to show a bit of humility here: I did a very stupid thing with an odds ratio where one of the contingency table cells was 0, and deleted a few tweets. Note: I hate logistic regression.Re-doing with a less stupid approach, hang on.
Noah Haber - @NoahHaber: ... currently waiting for sims to finish. New formula, now with 90% less stupid: OLS w/ sandwich so I can include 0's.So, assuming no spillovers and perfect compliance, etc, with fixed sample size, what combos of effect size and population-level incidence yields results?
Noah Haber - @NoahHaber: (to head this off at the pass: compliance is not part of the target effect in this case, since the relevant compliance comparator for ITT would be a gov't order, not an RCT arm, and the trial is explicitly trying to measure the effect of masks themselves).
Noah Haber - @NoahHaber: Here we go. X axis shows the multiple of the population case incidence in the trial population (i.e. 3x means that the trial cohort had 3x the cases detected), Y is the effect size (i.e. the proportion of cases prevented in expectation)
Noah Haber - @NoahHaber: Bottom line: even if we are being extremely generous, there were no spillovers, perfect compliance, and relatively high population incidence, we would not expect to see significant effects even in the case of relatively large protective effects.
Noah Haber - @NoahHaber: Whoops, forgot to include the sources:Case load source: https://en.wikipedia.org/wiki/COVID-19_pandemic_in_DenmarkPopulation source: https://worldpopulationreview.com/countries/denmark-populationAlso, the above calcs should be considered only slightly better than back-of-the-envelope. This is not a "serious" analysis of power, may be wrong, etc.
Noah Haber - @NoahHaber: Re-reading the above; I realize I neglected an important issue: They are testing the people wearing the masks. Broadly, the expected preventative effect is not so much for the mask wearer, as it is protecting spread to OTHER people (who are not being tested).
Noah Haber - @NoahHaber: Masks probaly don't have much protective effect to the wearer, but that has little to do with masks being effective broadly.Null result is expected due to design, study gives us little/no useful information if you understand these design issues, or misinformation if you don't.
Noah Haber - @NoahHaber: Note: don't take the back-of-the-envelope power calc above too seriously. The cases are cases, not infections (which are much higher, and are what is measured). The actual expected follow up is <6,000, effects detected are diluted, tests have error, etc.
Noah Haber - @NoahHaber: Point broadly remains; power is a big problem here.
Noah Haber - @NoahHaber: Closing the two threads here on Nov 19; please see where this picks up, the letter to the editor we wrote, the actual publication, etc.https://twitter.com/NoahHaber/status/1303742710562598918Citarhttps://twitter.com/NoahHaber/status/1303742710562598918Noah Haber - @NoahHaber: In advance of the Danish mask study's expected publication, Sarah Wieten (@SarahWieten), Emily Smith (@DrEmilyRSmith), and I have written our concerns about its framing and design.Our comments have been sent to DMJ editors, and are available on PubPeer.https://pubpeer.com/publications/47865E80A829070D6D64DDB57F3A70
https://twitter.com/NoahHaber/status/1303742710562598918Noah Haber - @NoahHaber: In advance of the Danish mask study's expected publication, Sarah Wieten (@SarahWieten), Emily Smith (@DrEmilyRSmith), and I have written our concerns about its framing and design.Our comments have been sent to DMJ editors, and are available on PubPeer.https://pubpeer.com/publications/47865E80A829070D6D64DDB57F3A70
Y si las conclusiones de un estudio no se ajustan a lo que hemos decidido por consenso que debe ser, ocurre lo siguiente, a pesar de que quien firme el artículo sea el director del Centro de Medicina Basada en Evidencia de la Universidad de Oxford
Taleb con argumento, no, Eric Weinstein como argumento de autoridad con paranoia WEF sí. ok.
si aplicase el modo de pensar conspiranoico le daría vueltas a que no será que ciertos intereses le marcan la dirección en el subconsciente (cuanto más virus, mejor) https://restoringtrials.org/competing-interests-tom-jefferson
magister dixit.
El Gobierno tendrá que regular por ley la vacunación para hacerla obligatoriaLa próxima llegada de una vacuna contra el coronavirus provoca una nueva colisión entre los derechos particulares y los colectivos. La vacunación no es obligatoria en España y el marco que ofrece el estado de alarma no sería suficiente para imponer una intromisión así en la esfera íntima del ciudadLa legislación actual es insuficiente y la más reciente protege el derecho del paciente a decidir. Bajo esta premisa, fuentes jurídicas consultadas coinciden en señalar que el Gobierno tendrá que regular por ley ese deber si considera esencial obligar a la población a vacunarse contra el covid-19, ya sea mediante el desarrollo de la legislación sanitaria en vigor o mediante una ley independiente que así lo establezca. El marco del estado de alarma no bastaría para imponer una intromisión de este calibre en la esfera más íntima de cada persona. En España, la vacunación no es obligatoria. La situación que se plantea ante el futuro desembarco de la vacuna contra el coronavirus provoca de nuevo una colisión entre derechos particulares y colectivos en un escenario en que sea necesario imponer el tratamiento preventivo. Son dos los textos legales que se contradicen en este punto. Por una parte, está la ya familiar ley orgánica 3/1986, de 14 de abril, de Medidas Especiales en Materia de Salud Pública, que establece que las autoridades sanitarias competentes podrán adoptar distintas medidas entre ellas de "tratamiento" o "control" en los casos en los que exista un peligro para la salud de la población. Por otra, la ley 41/2002, básica reguladora de la autonomía del paciente, que establece que toda actuación en el ámbito de la salud de un paciente necesita el consentimiento libre y voluntario del afectado, una vez que haya valorado sus opciones.El primero de ellos se ha empleado de forma continua en los últimos meses para imponer medidas de control del contagio. Ha sido el armazón sobre el que se han apoyado las autonomías para regular confinamientos perimetrales o restricciones en el derecho de reunión, siempre con el necesario aval de los Tribunales Superiores de Justicia. Su brevedad —solo tiene cuatro artículos— y falta de concisión han dado lugar a distintas interpretaciones. Además de esta norma existen otras anteriores, derivadas de la sanitaria del 44, que prevén obligación en casos muy concretos como la viruela o la difteria. La segunda de las leyes se ha interpretado recientemente por los tribunales con argumentos que refuerzan la idea de que será necesario un blindaje legislativo claro si el Ejecutivo desea eliminar lagunas e interpretaciones contrarias a la obligación. En un auto de la pasada semana, un juzgado de lo Contencioso-Administrativo de Oviedo denegó a los servicios de salud la autorización para el tratamiento médico forzoso a un anciano contagiado por covid. Considera que la ley de la autonomía del paciente exigía un consentimiento que en su caso no se había producido."La voluntad del paciente"En el auto, al que ha tenido acceso El Confidencial, el juez indicaba que no podía "obligar al paciente a someterse a tratamiento por vía intravenosa". "Toda vez que en este sentido habrá de respetarse la Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica, y el art. 52 de la Ley del Principado de Asturias 7/2019, de 29 de marzo, de Salud; debiendo para ello mediar el consentimiento libre y voluntariamente emitido al respecto", recalcaba.Añadía que sin constar un informe médico que acredite que el paciente tenga mermadas las facultades cognitivas o existieran factores que le impidieran decidir libremente sobre aspectos médicos referentes a su salud, "ha de ser la voluntad del paciente lo que deba tenerse en cuenta". Las fuentes consultadas insisten así en que la regulación por ley es la única vía para salvar estos escollos y consideran que esta obligación cumpliría los parámetros constitucionales en la actual situación. Desde el terreno político ya ha habido voces a favor de una norma expresa. La propuesta formulada por el presidente Alberto Núñez Feijóo va por este camino e implica establecer el "sometimiento a la vacunación" entre la población gallega. En el conjunto del Estado, el 57% de los ciudadanos manifiesta dudas sobre la posibilidad de administrarse una vacuna cuando esté disponible. Desde el Gobierno, Fernando Simón recordó recientemente que ninguna vacuna es obligatoria en España y confió en la "responsabilidad de los ciudadanos" para solucionar la crisis sanitaria. Por su parte, el ministro de Sanidad, Salvador Illa, ha insistido en que los expertos no son partidarios de una vacunación obligatoria contra el coronavirus porque esa estrategia no ha dado "resultados óptimos en otros países europeos". Se apoya, además, en la buena tradición de vacunación existente en España. El presidente del Gobierno, Pedro Sánchez, ha anunciado este mismo viernes que el próximo martes el Consejo de Ministros aprobará la estrategia de vacunación contra covid-19, con la previsión de que "una parte muy sustancial de la población española se vacune, con todas las garantías, en el primer semestre de 2021". Con este anuncio, Sánchez ha asegurado que España será "el primer país de la Unión Europea junto a Alemania" en tener un plan completo de vacunación contra el covid-19. "Hemos estado trabajando desde septiembre en este plan, que será aprobado el próximo martes en Consejo de Ministros. Estamos preparados. Nuestras previsiones son que, en casi cualquier escenario, una parte muy sustancial de la población podrá estar vacunada con todas las garantías a lo largo del primer semestre de 2021", ha señalado.